Doctors lament likely staffing shortage

By ANNE GEGGIS
http://www.news-journalonline.com

Sometime in the not-too-distant future, getting an emergency appendectomy could require hitting the highway to either Orlando or Jacksonville.

That’s the grim prognosis coming from two veteran general surgeons in the area who are alarmed that retirement is draining their ranks with no apparent effort to re-invigorate the supply. It’s a problem reflected throughout medicine — and particularly in its primary disciplines such as general surgery and family practice.

Consider that the population of Volusia and Flagler counties has increased nearly 20 percent in the last 18 years while the number of general surgeons covering emergencies at the area’s regional hospital — Halifax Health Medical Center — has decreased by about one-third.

“We need to find a way to increase the number of general surgeons, orthopedics, OB GYN, family practice,” said Dr. Harry Black, a general surgeon at Halifax Health in Daytona Beach. “All those primary specialties are lacking.”

Black was no longer required to take emergency calls at Halifax Health after 18 years of it. But he’s still pitching in to help the remaining seven on the rotation with a duty that can keep a doctor up all night, depending on what random surgical emergency shows up in the emergency room.

“It just eats on the people who are doing it,” he said.

Hospital administrators, however, are not so concerned.

“While it is true that there is a national shortage, the situation has not come to be an issue in Volusia County,” said Darlinda Copeland, chief operating officer of Florida Hospital Ormond Memorial.

Others, however, see a crisis ahead: Besides Florida, only Montana, Vermont and Wyoming have a lower percentage of doctors younger than 40, according to the Association of American Medical Colleges. Only three other states have more doctors older than 60.

“We’re an aging group and, unfortunately, we’re not seeing as many young people interested in coming into medicine as were at one time,” said Donald Stoner, chief medical officer at Halifax Health.

Stoner said he doesn’t believe routine surgical emergencies will need transport out of the area, but the area’s largest health care provider is studying the problem.

“Our average age (among doctors) is greater than 48, and 20 percent of our physicians are over 60,” he said.

There are more factors at work. With Baby Boomers aging and needing more care, the country’s over-65 population is growing much faster (50 percent over the next 15 years) than the under-65 set (projected to grow at 9 percent). Aggravating this demographic disparity, medical schools had been holding down the numbers of student doctors, believing a glut of doctors was in danger of forming.

“We’re still paying the price for that,” Halifax’s Stoner said.

Economic issues are in play, too, so becoming a doctor is no longer a sure path to the upper middle class. Medical school debts are up — an estimated average of $150,000 per student; insurance company reimbursements are down; liability insurance costs are up.

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As a result, more young doctors are following the money into more profitable specialties that have more predictable hours.

Dr. Stephen Levine, 57, gave up practicing general surgery and decided to concentrate on wound care and Lap-Band surgery that shrinks the appetite of obese patients. His 20-year-old son’s death led him to re-examine the life that had him working day and night.

“I was not willing to go on and sacrifice everything,” Levine said. “I really had no life for 20 years. I had to think more about myself.”

The American Association of Medical Colleges began calling last year for a 30 percent increase in enrollment, but a fix for the problem will have to go beyond that, doctors and hospital administrators agree.

In spite of the need to increase the capacity, no new Medicare funding for medical residencies has been provided since 1997, according to Doug Carlson, spokesman for the Florida State University College of Medicine, the first U.S. medical school to open since 1982.

Not many have an accurate picture of the problem, according to Nir Menachemi, an associate professor of health care organization policy at the University of Alabama-Birmingham. Research he helped spearhead led the state Department of Health to require physicians to fill out a survey on their age and plans about retirement when they renew their license.

“So instead of being able to base decision on speculations or opinions, you can run the numbers and see how they’ve changed over the last five years,” he said.

Family practice doctor James Carratt doesn’t need a survey to know that most of his contemporaries have either died or retired. One of the area’s oldest physicians won’t say how old he is, but suffice to say, he started practicing here when President Dwight Eisenhower was still in office.

He has about 15 to 20 patients a day and makes hospital rounds daily, if needed.

“There’s quite a few family physicians around here,” he said, crediting Halifax’s Family Practice Residency Program with the area’s relative bountiful supply of them. “But I think eventually there’s going to be a shortage.”

Don’t blame Carratt, though; he’s not going to go unless he absolutely has to: “What else would I do?”